UH3 Project: Pragmatic Trial of Video Education in Nursing Homes (PROVEN)
Sponsoring Institution: Brown University School of Public Health
NIH Institute Providing Oversight: National Institute on Aging (NIA)
Program Official: Marcel Salive (NIA)
Project Scientist: Jeri Miller (National Institute of Nursing Research [NINR])
ClinicalTrials.gov Identifier: NCT02612688
Locations: Nursing homes in Genesis HealthCare and PruittHealth healthcare systems
Trial Status: Currently recruiting participants
Nursing homes are complex health care systems that serve increasingly sick patients who have advanced comorbid conditions. Nursing homes are often charged with guiding patients through decisions about the direction of their treatment. Patients at nursing homes commonly get aggressive care that may be inconsistent with their preferences and of little clinical benefit. Identifying effective approaches that nursing homes can use to better promote goal-directed care within existing resources is a research, public health, and clinical priority.
Advance care planning (ACP) is the most consistent modifiable factor associated with better palliative care outcomes. Traditional ACP relies on verbal descriptions of hypothetical health states and treatments. This approach is limited because complex scenarios are difficult to envision, counseling is inconsistent, and verbal explanations are hindered by literacy and language barriers. To address these shortcomings, the PROVEN project has developed video-assisted ACP decision-support tools that have shown efficacy in small randomized controlled trials. While several large health care systems have begun to adopt the videos, efforts have not rigorously evaluated outcomes—a critical step prior to widespread implementation. The goal of PROVEN is to conduct a pragmatic cluster-randomized trial to evaluate the effectiveness of the ACP video tools in the nursing home setting by partnering with 2 large health care systems that operate 492 nursing homes nationwide. This work has the potential to improve the care provided to millions of older Americans in nursing homes and enable future pragmatic trials in this setting.